MR Imaging–based Assessment of the Female Pelvic Floor

Pelvic floor weakness is a functional condition that affects the anatomic structures supporting the pelvic organs: fasciae, ligaments, and muscles. It is a prevalent disorder among people older than 50 years, especially women, and may substantially diminish their quality of life. Many complex causes of pelvic floor weakness have been described, but the greatest risk factors are aging and female sex. Pelvic floor weakness can provoke a wide range of symptoms, including pain, urinary and fecal incontinence, constipation, difficulty in voiding, a sense of pressure, and sexual dysfunction. When the condition is diagnosed solely on the basis of physical and clinical examination, the compartments involved and the site of prolapse are frequently misidentified. Such errors contribute to a high number of failed interventions. Magnetic resonance (MR) imaging, which allows visualization of all three compartments, has proved a reliable technique for accurate diagnosis, especially when involvement of multiple compartments is suspected. MR imaging allows precise evaluation of ligaments, muscles, and pelvic organs and provides accurate information for appropriate surgical treatment. Moreover, dynamic MR imaging with steady-state sequences enables the evaluation of functional disorders of the pelvic floor. The authors review the pelvic floor anatomy, describe the MR imaging protocol used in their institutions, survey common MR imaging findings in the presence of pelvic floor weakness, and highlight key details that radiologists should provide surgeons to ensure effective treatment and improved outcomes.